Department of Orthopedic Surgery, The Johns Hopkins University, Baltimore, MD.
Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
Spine (Phila Pa 1976). 2018 Jun 1;43(11):791-797. doi: 10.1097/BRS.0000000000002481.
Retrospective comparative study.
The purpose of this study is to compare functional outcomes, hospital resource utilization, and spine-related costs during 2 years in patients who had undergone primary or revision surgery for adult spinal deformity (ASD).
After surgery for ASD, patients may require revision for pseudarthrosis, implant complications, or deformity progression. Data evaluating cost-effectiveness of primary and, in particular, revision surgery, for ASD are sparse.
We retrospectively reviewed records for 119 consecutive patients who had undergone primary or revision surgery for ASD. Two-year total spine-related medical costs were derived from hospital charge data. Functional outcome scores were extracted from prospectively collected patient data. Cost utility ratios (cost/quality-adjusted life-year [QALY]) at 2 years were calculated and assessed against a threshold of $154,458/QALY gained (three times the 2015 US per-capita gross domestic product).
The primary surgery cohort (n = 56) and revision cohort (n = 63) showed significant improvements in health-related quality-of-life scores at 2 years. Median surgical and spine-related 2-year follow-up costs were $137,990 (interquartile range [IQR], $84,186) for primary surgery and $115,509 (IQR, $63,753) for revision surgery and were not significantly different between the two groups (P = 0.12). We report 2-year QALY gains of 0.36 in the primary surgery cohort and 0.40 in the revision group (P = 0.71). Primary instrumented fusion was associated with a median 2-year cost per QALY of $197,809 (IQR, $187,350) versus $129,950 (IQR, $209,928) for revision surgery (P = 0.31).
Revision surgery had lower total 2-year costs and higher QALY gains than primary surgery for ASD, although the differences were not significant. Although revision surgery for ASD is known to be technically challenging and to have a higher rate of major complications than primary surgery, revision surgery was cost-effective at 2 years. The cost/QALY ratio for primary surgery for ASD exceeded the threshold for cost effectiveness at 2 years.
回顾性对比研究。
本研究旨在比较初次手术和翻修手术治疗成人脊柱畸形（ASD）患者在 2 年内的功能结果、医院资源利用和脊柱相关成本。
ASD 手术后，患者可能需要进行翻修，以治疗假关节、植入物并发症或畸形进展。评估 ASD 初次手术和特别是翻修手术的成本效益的数据较为匮乏。
我们回顾性地分析了 119 例连续接受 ASD 初次手术或翻修手术的患者的记录。通过医院收费数据得出 2 年总脊柱相关医疗费用。从前瞻性收集的患者数据中提取功能结局评分。计算 2 年的成本效用比（成本/质量调整生命年[QALY]），并与 154458 美元/QALY 的阈值（2015 年美国人均国内生产总值的 3 倍）进行比较。
初次手术组（n=56）和翻修组（n=63）在 2 年时的健康相关生活质量评分均有显著改善。初次手术的中位手术和脊柱相关 2 年随访费用为 137990 美元（四分位距 [IQR]，84186 美元），翻修手术的费用为 115509 美元（IQR，63753 美元），两组之间差异无统计学意义（P=0.12）。我们报告初次手术组 2 年 QALY 增加 0.36，翻修组增加 0.40（P=0.71）。初次脊柱内固定融合术的中位 2 年每 QALY 成本为 197809 美元（IQR，187350 美元），而翻修手术的成本为 129950 美元（IQR，209928 美元）（P=0.31）。
与初次手术相比，ASD 翻修手术的总成本更低，QALY 获益更高，尽管差异无统计学意义。尽管 ASD 翻修手术在技术上具有挑战性，且比初次手术的主要并发症发生率更高，但在 2 年时，翻修手术具有成本效益。初次手术治疗 ASD 的成本/QALY 比值在 2 年内超过了成本效益的阈值。
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